Suggested Citation: Sariipek, D. B., & Çuhadar, S. G. (2017).

Implementation of
a "Self-Sufficient Ageing" Policy and Possible Challenges: Case of Turkey. In Ł.
Tomczyk & A. Klimczuk (Eds.), Selected Contemporary Challenges of Ageing
Policy (221-256). Kraków: Uniwersytet Pedagogiczny w Krakowie. Doi:
10.24917/9788380840911.10

DOGA BASAR SARIIPEK1

SEYRAN GÜRSOY ÇUHADAR2

Implementation of a “Self-Sufficient Ageing”

Policy and Possible Challenges: Case of Turkey

Abstract: The policies of socioeconomic protection of older

adults in most parts of the world are being redesigned in the scope
of value-added targets, such as active ageing, successful ageing, or
creative ageing. The main purpose here is, of course, enabling
older adults self-sufficient and beneficial both for themselves and
their social environment, instead of being simply the passive
beneficiaries of the public support mechanisms. Turkey has a
population which is still young but ageing very rapidly and will
reach to the same point as Europe today in a relatively much
shorter time. However, the country still seems to be away from
conducting systematic and holistic measures, except for a few
ineffective strategy papers and legal regulations. Therefore,
Turkey must immediately design a new policy agenda in
conformity with its traditional and historical advantages.
Revitalizing the intergenerational solidarity bonds, in this regard,
may be the best cost-effective solution to complement formal
measures in the provision of social protection and in the process of

1
Doga Basar Sariipek, Kocaeli University, Turkey, sariipek@kocaeli.edu.tr.
2
Seyran Gürsoy Çuhadar, Kocaeli University, Turkey,
seyrangursoy@gmail.com.

221
active ageing. However, this traditional protection net is under
attack of increasingly transforming socioeconomic conditions.
Consequently, as one of the most rapidly ageing countries in the
world, Turkey should immediately stimulate studies and debates
over a healthy, functional, and effective ageing period and caring
issues. Otherwise, governments will be blindsided by the
socioeconomic, psychological, cultural, and physiological
problems related to the ageing process. In the light of these facts,
the main purpose of this study is to discuss policy
recommendations to create a self-sufficient ageing period for older
adults in the context of Turkish case.

Key words: Ageing, Third Age, Fourth Age, Older Persons Care,
Turkey, Informal Care

Introduction
The issue of population ageing, which can be defined as the
increase in the number of older adults in the society, is doubtlessly
one of the most remarkable demographic issues of the twenty-first
century. A much more important point is the fact that this process
will continue to maintain its importance during the rest of the
century. According to the projections on this matter, the
population of older adults over 60 is estimated reach to 1.2 billion
by the year 2025; 1.3 billion by 2040 and 2 billion by 2050.
Furthermore, it is also predicted that older adults over 85 in the
“fourth age” group will outnumber six times more the ones over
65 in the “third age” group at the end of the first half of the 2000s
(TYDYUEP, 2013, p. 4).
At first, the issue of population ageing was only a problem
for developed countries. However, it has recently been observed in
many developing countries, too. Moreover, in the very near future,
it is certain that almost all countries will face the problem of
population ageing at different periods of time, at different density
and pace.
Behind this claim, there are some factors such as the decline
in the birth-rate, improvements in the nutrition, and developments
in the healthcare and technology and as a result of these, people
started to have a lot longer lifespan. In this context, for instance,

222
the longevity extended 20 years more in Europe between the years
1900 and 1950. It is expected that this will be added ten years
more in 2050 (SPO, 2007, p. 6). The data from the World Health
Organization shows that the rate of older adults in Europe will
reach 25% of the whole population in 2050 (WHO, 2016).
Population ageing is not merely a demographic
transformation, and it means a series of a burden on the society.
Ageing is not only an inevitable physical process, but it also leads
to a lot of relevant results on community health care and
socioeconomic and cultural structure. In this sense, there becomes
a pressure on the labor force and finance market; a vast increase in
the demands on goods and services such as accommodation,
transportation, and social protection; so, it is inevitable that the
family structure and the connection between generations will be
affected negatively. In fact, together with the increase in ageing,
significant concerns have aroused on the sustainability of the
social support systems and solidarity among generations, which
are directly effective on the level of welfare of both young and old
generations. These concerns have risen since the number of
traditional large families decreased and the number of nuclear
families increased. Women who traditionally used to be
responsible for caring the family have joined the labor market
more. This has also increased concerns, too.
Therefore, it is crucial to be able to foresee the economic
and social transformations related to ageing. This is important for
the countries’ development process. That is why, it is necessary to
have a holistic and multi-branch political package empowered
with perspectives such as social security, healthcare, environment,
education, socio-cultural activities, and family life. As the
population of the countries ages, it becomes critical for the
governments to design public services and innovative policies in
the fields of healthcare, employment, accommodation, and social
security directly for older adults.
When we look at the issue of population ageing regarding
Turkey, it is understood that Turkey has similar features to other
developing countries. However, it is also observed to have
distinctive features, too. The total population in Turkey is
approximately 77 million, and there are about 6.5 million older

223
adults over 65, and this is 8.2% of the population. Even though
Turkey statistically seems to be a young country, it is, in fact, a
state that is getting older very fast. As a matter of fact, it is
calculated that the rate of older adults which was 5.7% in 2005
will have risen to 17.6 % by 2050. Therefore, ageing is a
significant problem for Turkey, which has to be seriously taken
into consideration and urgent precautions have to be taken.
Because the population grows fast, the need for care for older
adults grows at the same speed, too. As a result, there will be
significant pressure on the society in the very near future,
especially in the social security services. Therefore, the
governments of Turkey need to see this challenge that is
approaching very fast, and it needs to take necessary institutive,
humane, and legal precautions urgently.
However, in Turkey, no systematic and rights-based policy
for the care for older adults has been applied up to date. One of the
most important reasons of these is doubtlessly the fact that Turkey
was a country with a young population in the majority of the
twentieth century. In addition, almost all needs of older adults
have been traditionally met with the solidarity among family
members and support systems so far. This informal solidarity and
caring system have relieved the governments, and this has led to a
delay of the systematic precautions to be taken for the care for
older adults for extended years. In recent years, the older
population has increased, and the family structure has changed;
together with that, there have been a lot of demographic changes.
All these things have caused a failure in informal support network.
For this reason, the state ought to develop a new approach to care
for older adults. Nevertheless, when we look at the development
plans for the last 50 years and governmental projects, it can be
concluded that the government is not aware of the ageing problem.
It is understood that the government still approaches to this issue
with traditional methods and mechanisms. This means that the
state in Turkey uses old solutions of the twentieth century for a
problem of the twenty-first century.

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The Phenomenon of Ageing
Ageing is a phenomenon dealt with various aspects. Therefore,
many different definitions are found in the literature. Even though
it is mostly emphasized in these notions that ageing is a biological,
chronological, and physiological process, there have been different
approaches to ageing in recent periods such as active ageing,
successful ageing, and ageing in place. At the same time, there are
definitions that consider the ageing phenomenon as an age
discrimination such as “although the mental capacity is kept, the
energy and coherence skill decrease, hence the ability to perform
work is lost” (Büken, 2010, p. 33). These definitions have
correlated ageing with the loss of abilities. If we need to make a
general evaluation of these definitions, it can be understood that
biological ageing is restricted with “anatomical and physiological
functional changes, yet chronological ageing is defined by
considering one-year units in time” (Güler, 1998, p. 105).
Physiological ageing is when the person feels old, and he accepts
himself as old. It is defined as the changes emerged from the
decrease in mental skills, mental functions, and behavioral
compatibility (Hablemitoğlu and Özmete, 2010, p. 19). Another
type of ageing is social ageing which means that the person loses
strength and stays away from his work and social life (Öztürk,
2015, p. 7).
Besides these classical approaches to ageing, some new
approaches that are appropriate for social, economic, and even
political transformations have emerged in recent periods. The first
of these is the active ageing concept, and it is defined as the
process of promoting the health, participation and caregiving
institutions for older adults to raise the quality of their lives as
they get older (WHO, 2002b). Another approach for older adults is
successful ageing, which was defined long before the notion of
active ageing and which is, in fact, a more detailed approach
covering the active ageing process, too. In other words, a
successful ageing concept is a multi-dimensional approach that
covers not having a disease, maintaining functional capacity, and
participating life in an active way (Özmete, 2012, p. 2).
All these definitions explain ageing with a minimum one
dimension. However, there is not an agreed definition about at

225
what age a person should be called “old.” According to the World
Population Ageing Report, which was released by the United
Nations Statistics Unit in 2013, one of the contemporary sources
about this issue; the population aged 60 and over is accepted to be
an older person unless a different explanation is made (UN, 2013,
p. 3). At the same time, the World Health Organization accepts the
age 65 as “chronologically old” in the majority of developed
countries, yet this definition is not enough for under-developed
countries (WHO, 2002a).
However, the average life expectation is getting longer, and
the population of the 65 and over is increasing rapidly. As a result,
the older population is divided into sub-groups, and the policy to
be applied should be determined according to this division. In fact,
the process of ageing and the requirements emerged from this
differs for both the individuals and the age groups. In this concept,
the start of the older age period can be different for every person
in connection with primary ageing with chronologically getting
older. On the other hand, it can also be different for every
individual with different lifestyles and social pressures determined
by emotional disturbance, illnesses, malnutrition and unhealthy
diet, and stressful lifestyles (Hablemitoğlu and Özmete, 2010, p.
19).
The third and the fourth age concepts, which have been
used more often in recent periods, are in fact a reflection of this
situation. According to this, it is expressed that life will be divided
into more than one ageing period (Laslett, 1991) and in today’s
world, concepts of third age and fourth age have often been used
similarly to previously used classifications such as “young-old”
and “old-old”3 (Neugarten,1974).

Third and Fourth Age: A Conceptual Frame

The world population has been ageing rapidly especially in the
developed countries. Moreover, this affects the societies socially,

3
For the definition of the WHO, please check “A Glossary of Terms for
Community Health Care and Services for Older Persons,”
www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf?ua=1.

226
economically, politically, and even culturally. As a result, new
policies need to be applied. However, societies do not get older
homogeneously. This means that there is discrimination in the
ageing period when different age groups are getting older at a
different speed and diverse ways, and they have different needs
and demands. The third age and the fourth age classification may
be interpreted as the result of discrimination.
In this frame, while the third age is defined as “the period of
amenities” because of the opportunities it offers, the fourth age is
defined as the “period of threats” because of the problems and
threats it holds. The Figure 1 and Figure 2 below illustrate the
different formation process of the third and fourth age periods in
Turkey.

Figure 1 Third Age (65-85 Years Old) in Turkey, 2000-2015

Source: Compiled from TurkStat datasets by authors.

Defining the subgroups of older age population is an

attempt to illustrate that older age population has heterogeneous

227
characteristics regarding social participation, death rate, and the
need for social care; thus, all these demands differ for each older
adult. In this context, it will be useful to divide older adults into
“the third age” and “the fourth age” groups for designing a future
to old age population. All in all, it is observed that the third and
the fourth age are defined in two ways. The first is the population-
based definition, and the latter is individual-based definition. Both
definitions are extremely necessary and useful to comprehend the
idea in different concepts, and to give way to evaluations and
interpretations of various ages and that they are different.

Figure 2 Fourth Age (85+ Years Old) in Turkey, 2000-2015

518436
475435
440667
405699
364022
317312
279675 278397
216500 235397

Source: Compiled from TurkStat datasets by authors.

According to the population-based definition, the transition

from the third age to the fourth age starts when at least 50% of the
ones born at the same time or in the same year are not alive. Such
criteria increase the possibility of the fact that those individuals at
later periods of this age are in real ageing process. According to
this definition, the transition from the third age to the fourth age
starts in their 75 or 80s in developed countries (Olshansky, Carnes
and Désesquelles, 2001, p. 1491; Vaupel et al., 1998, p. 857;
Kannisto, 1996). In developing countries, however, this transition
starts at earlier ages; it differs in a larger scale from 55 to 70,
depending on the fertility rate and the average lifespan.
The real aim at the individual-based definition is observed
to predict the maximum lifespan of the individual rather than

228
predicting the average life expectancy of the population. A person
can be expected to live maximum 80 or 120 years in today’s
conditions if we exclude some specific diseases that prevent a
person to have a longer life. According to this, the transition for
the individual from the third age to the fourth age can start at the
age of 60 whereas it starts at the age of 90s for others (Finch,
1996, p. 494; Manton, 2001, p. 307).
This third and fourth age discrimination can be evaluated as
a contribution to the explanations under different names done
before. Long ago, Neugarten claimed (1974) that old age was not
only one period in a lifetime, on the contrary, but it must also be
divided into different sub-groups, and he did this division as
“young older adults” and “old older adults.” However, the most
remarkable claims on this issue belong to Peter Laslett (1991).
Laslett is considered to be the first who argued that life could be
divided into many old age periods. His claim is based on
underlining the originality and uniqueness of the third age period.
However, the determination of “which older adults belong
to which age group?” is the question whose answer remains
unclear. It will be better to talk about common approaches rather
than precise determinations on this matter. In this context, the
beginning of the third age period is accepted when the person quits
his active and productive work life and gets retired (Smith, 2000,
p. 4; Guidance for the Elderly, 2016). It is the last part of the third
age period or the beginning of the fourth age period when ones
start to have physical, emotional, and mental limitations related to
his or her age. Therefore, the third age is usually between
approximately 65 and 80 (or 85) in today’s world (Barnes 2011, p.
1).
The third age is a concept which is considered to be a period
where a healthy life is highly expected and which is believed to
have risen the living standards of the retired people in their later
life (Laslett, 1991). Moreover, it is defined as the “golden era” of
the adulthood by many researchers (Barnes, 2011, p. 1). The
contribution by Laslett to the argument is that new conditions of
this later life can be formed with personal interests and expressing
themselves when the formal employment period is over, and
necessary family responsibilities have been completed. In this

229
frame, new definitions and concepts about ageing have been
suggested such as “usual and successful ageing” (Rowe and Kahn,
1987) and “productive ageing” (Weiss and Bass 2002, p. 5).
As clearly seen in Table 1, it can be observed that the group
aged 85 and over, that is the fourth age group, is increasing a lot
faster than the whole of the old age population in Turkey. In other
words, it is, of course, understood that the fastest-growing group
of older adults is the fourth age group (SPO, 2007, p. 5). There is,
in fact, conformity between this data and the future predictions
about ageing in the world. According to this, it is estimated that
the number of older adults in the fourth age group will be tripled
to 434 million by the year 2050, which was 125 million in the year
2015 (UNFPA, 2015, p. 2). This rapid increase in the old age
population has clearly been emphasized in other global reports,
and there have been warnings. For instance, according to the
World Health Organization, the number of older adults in the
fourth group will be six times higher than those in the third group
at the end of the first half of the 2000s (WHO, 2002b).
Table 1 The Increase Rate of the Third and Fourth Age
Groups in Turkey, 2000-2015
65-85 85+ 3. age rate 4. age rate
2000 3642449 216500 0,0537 0,00319
2007 4720500 279675 0,0669 0,00396
2008 4658026 235397 0,0651 0,00329
2009 4805017 278397 0,0662 0,0038
2010 5010424 317312 0,068 0,0043
2011 5126693 364022 0,0686 0,0049
2012 5276304 405699 0,0698 0,0054
2013 5451027 440667 0,071 0,0057
2014 5717527 475435 0,0736 0,0061
2015 5976803 518436 0,0759 0,0066
Source: Compiled and calculated from TurkStat datasets by
authors.
Under these conditions, social service and assistance
programs for older adults need to be designed separately for each

230
age group. Because it is possible for a society to have a successful
and productive ageing period and the possible adverse effects of
this process on the economical, social, and political structure and
especially on social security systems can be removed only when
different ageing policies are designed for different sub-groups.
Exactly at this point, Turkey seems to be unsuccessful. Because
even though Turkey is still in the last phase of the demographic
window of opportunities, it grows old much faster than similar
countries and it is observed that political decision-makers in
Turkey does not seem to have realized this. In addition, no
separation in ageing policies has been done yet. Therefore, the
issue of the fourth age period, in which we will face a serious
challenge in a very near future, is still dealt with the third age
perspective.

The Theory of Demographic Transformation and the

Situation in Turkey
The theory of demographic transformation predicts a transition
from a period when nations had high birth rates and low death
rates to a new period where death rates decrease, and birth rates
are deliberately controlled (Özbay, 2015, pp. 254-255; Yüceşahin,
2011, p. 11). The demographic transformation consists of three
stages, and at the first stage, pre-industrialization stage, both the
birth rates and the death rates are high; and the rate of increase in
population is at the minimum level. At the second stage of the
transformation, the mortality rates start to go down because health
and life conditions have improved as a result of industrial
revolution and this is followed by a decrease in the birth rates.
Therefore, rapid growth in population is observed at this stage. At
the third and final stage of the transformation, the increase in
population is at the minimum level just like at the first stage, and
the birth and death rates go down to a very low level. According to
this theory, all societies will inevitably go from a stage where the
fertility and death rates are very high to another stage where both
rates are lower (Teitelbaum, 1975, p. 421; Kinsella and He, 2009,
p. 20).
The theorists claim that every country will experience the
same demographic evolution but at different times because of the

231
modernization, industrialization and urbanization. According to
this, the demographic transition will be observed firstly in Europe
and North America, later in Asia and Latin America and finally in
sub-Saharan African countries (Lee, 2003, p. 172).

Figure 3 Population Pyramid

Source: UN, World Population Ageing 1950-2050.

The Figure 3, which belongs to the United Nations, shows

the global population pyramid including the years 1950, 2000 and
2050 and it seems to prove the theory of demographic
transformation. As understood from the graph that the population
of those under the age of 20 covers a vast scale compared to those
over the age of 60 in the year 1950 and that is because the shape
looks similar to a pyramid. However, when we look at the figures
of the year 2050, the shape of the graph looks similar to a column
rather than a pyramid, which is a characteristic of the age pyramid
of the developed countries. It is predicted that while there is a
decrease in young age population, there will be an increase in old
age population.
When the situation in Turkey is examined, the population
structure was understood to have been designed through various
population policies since the Proclamation of the Republic. In this
context, the history of the population policy consists of three
periods. The first period is called “pro-natalist” between the years
1923 and 1955. The second is a period of the years 1955 and 1980
when the “anti-natalist” policy was dominant. The final period is
after the year 1980 when the anti-natalist policy was settled (Koç
et al., 2010, p. 48).

232
 If it is necessary to make a general evaluation that covers all
these periods, we have signs that show continuous improvements
in socio-economic areas especially in mother and child healthcare;
this has resulted in dramatic decreases in deaths of children under
the age of 5 and the number of births-per-woman. So, Turkey has
gone through the final stage that was mentioned in Turkey’s
demographic transformation theory. That means Turkey is no
longer a young country which used to have high birth and death
rates; it has become an ageing country which has lower birth and
death rates (Koç et al., 2010, p. 4). On the other hand, when it is
compared to European countries, it is observed that the population
rate of older adults aged 65 and over is not as high. However, the
problem in Turkey that must remarkably be underlined is the
speed of ageing.
If it is necessary to express directly, Turkey is getting older
a lot faster than the countries in a similar situation. For example,
as seen in Table 2, old age population in France needs to take 115
years to go up from 7% to 14% whereas only 21 years will be
enough for the same increase rate in Brazil. A similar difference in
ageing speed is a pic for discussion for Turkey and the whole of
Europe. It is predicted that Turkey will take 27 years to reach the
ageing period when it is almost 100 years in Europe. The United
Nations Projections show that in Turkey, the population over the
age of 60, which was 11.2% in 2015, will be 17% in 2030 with a
5.9% increase rate, and it will reach 26,6% in 2050 (UN, 2015, p.
147).
This situation shows that the demographic transformation
period will take a shorter time in the countries such as Turkey,
where this process has been delayed (TUSIAD, 1999, p. 6; Koç et
al., 2010, p. 5). It can clearly be seen in the Population Report
prepared by Kinsella and He (2009). According to this report, old
age population in the world is densified in industrialized areas of
the North America and Europe, the rate of the old age population
in developing countries is much more rapidly than those in
developed countries.

Table 2 Ageing Speed in Turkey and Some Other Countries*

233
 The year The year Transition
reaching reaching period
Countries %7 of the %14 of the (year) of
general general the general
population population population
France 1865 1980 115
Developed Sweden 1890 1975 85
Countries USA 1945 2013 69
England 1930 1975 45
Azerbaijan 2004 2037 33
Developing Brazil 2011 2032 21
Countries South Korea 2000 2018 19
Turkey** 2012 2039 27
*The transition time of the population of 0-65 and over from 7%
to 14% in Turkey
**Turkey, calculated from the data of TurkStat.
Source: Kinsella and Gist (1995).

When compared to European countries, it is understood that

Turkey is getting older nearly twice faster than other countries. It
was also understood that this situation caused Turkey to be found
unprepared about the social politics for older adults (Danış, 2014).
Therefore, both a radical social politics package and a new
population politics are necessary to produce remedies for these
problems.

Care for Older Adults in Turkey and the Level of Socio-

Economic Security
Numerous universal declarations have confirmed that the issue of
care for older adults cannot be left to the mercy of informal
solidarity; a legal and rights-based formal caring system must be
founded. For example, the 25th Article of Universal Declaration of
Human Rights includes the right to social security for older adults.
Also, the World Health Organization has obvious focuses and
targets directly for older persons and seniors care. Besides these,
First and Second Older Adults Assemblies have been organized to
emphasize the importance of older adults issue, and it has been

234
tried to draw the public attention to how a respected ageing can be
provided.
Even though the formal side of older persons’ care is
emphasized in those universal texts and assemblies, informal
relation networks are not totally excluded. For example, in 1994,
the issue of ageing was specifically mentioned in the International
Conference on Population and Development in Cairo. During this
conference, some targets were set to provide family members with
a necessary support system to look after an older family member,
and targets to create basic healthcare for older adults and to form
economic and social security systems. In other words, it was
argued at the conference that informal networks have to be
designed to work on the right and effective ways; and it should be
designed in the way that there is a successful coordination
between the formal and informal networks. It was predicted that
older adults could be a good source for the development of the
country only when it is done in that way.
As in every country, in Turkey, too, formal, and informal
support networks have been applied intensely. Under normal
conditions, these two sources should complete one another instead
of replacing each other. However, it is not easy to say that there
has been a balanced relation between these two. On the contrary,
there is a reversal, opposite relation between them. Family and
kinship solidarity in Turkey, other inter-individual and relational
networks such as neighborhood or citizenship and some informal
and voluntary mechanisms such as non-governmental
organizations, have always been traditionally powerful and
governmental organizations, which are the formal part of the care
for older adults, have been the complementary part of it. In short,
the idea that older persons’ care is an issue which must be solved
inside the family dominates the social politics of the state. For
instance, “The Action Plan for Ageing,” which was released in
2013, clearly included the statement: “the feelings of love and
mercy, rooted in Turkish culture, have put the rights of older
adults on the focus of families.” Other documents and
explanations, which reveal the tendency of the state and the
governments to leave older persons’ care to the informal and

235
voluntary networks, will be examined in a detailed way at the end
of this study.

Informal Care for Older People in Turkey

In the pre-capitalist countries, while the family met all the
physiological, physiological, and sociological needs of the
individuals, it socially had the characteristics of being the unique
and independent structure that helps to recreate the society
(Özbay, 2015, p. 32). In these periods, when the large and
patriarchal family structure was dominant, the family used to take
direct responsibility for the care for older adults besides other
social protection responsibilities. This caring system by the family
was fed with some ideological basis such as religious and cultural
values, and it became the only source to provide care for older
adults. These characteristics of the families have relieved the
governments by saving them from the trouble of the expenses for
starting a systematic and rights-based care system for older adults
(Özbay, 2015, p. 59).
The family structure in the pre-capitalist period is extremely
coherent with the structure of the population. In these societies,
the population increased at a very slow speed yet still there were
high fertility and death rates (Özbay, 2015, p. 51). When we look
at the situation in Turkey, it is understood that all these
characteristics were observed especially before the year 1950. The
serious decline in the number of male adults was observed because
of the significant losses during the war (Shorter, 1985). Also, it
was also known that many Greek families had immigrated to
Greece during the War of Independence (Keyder, 1982). All these
events have created negative pressures on the re-creation capacity
of the society.
Even though Turkey has many typical characteristics of
societies in pre-capitalism, it also shows distinctive features at
some points, too. In a clearer expression, despite the fact that the
traditional family and kinship relations had been strong for
hundreds of years, it will not be true to describe Turkey as an
individualist or communitarian country. There are many reasons of
this. That is why it will be better to describe Turkey’s human
development model as “interdependence model.” Communitarian

236
and individualist tendencies can be found in a special synthesis
and balance in this model. In such a society, families have the
leading roles in meeting the needs of older adults. The number of
older adults who never get any caring support from their families
is rather low. A relatively negative part of this situation is that
families can sometimes be unwilling to search and accept the
institutional aid and support programs prepared for older adults
(Imamoglu, 1987). This unavoidably decreases the possibility of
the concept of a rights-based concept to settle in this area.
The care for older persons is still a problem that must be
solved inside the family because of insufficient development of
formal care system in Turkey, and it directly depends on the good
faith of the families. According to a traditional family structure,
care for older adults is the spouse’s responsibility in the first place.
However, if the spouse is similarly old and cannot look after her
husband or wife, this responsibility passes to the children.
Thanks to the extremely strong and traditional family ties in
Turkey, most of older adults still live with their children in the
same flat, building or the same neighborhood, and they lead their
lives under their protection, observation, and close interest.
According to a survey that was performed by the State Planning
Organization, seven out of every ten older adults live with their
children in the same house and building or neighborhood (SPO,
2007, p. 11). This enables the family to support older adults both
socially and economically, and it helps the state’s responsibility to
provide social protection.
However, a series of pioneer improvements in recent
periods, such as industrialization, urbanization, and capitalization,
led the family to lose this characteristic. Some reasons, such as the
start of agricultural modernization in the first years of the 1950s,
the rapid decrease in the death rates, the concealed unemployment
caused by a continuous rise in the population, and the shortage of
fertile lands, started the migration from rural areas to urban areas.
This changed the urban and rural population distribution (Özbay,
2015, pp. 84-85). When it comes to 1968, the rate of patriarchal
families consisted of nearly one-fifth of all families (Özbay, 2015,
p. 86). All these changes especially socioeconomic ones changed

237
the basic function of the family and similarly, the attitude towards
older adults differed.
This situation is a more visible problem especially in
metropoles where social life passes a lot faster. In the end, the
status of older adults and their functions in the society, social
foundations, attitudes, and values seriously change because of the
processes mentioned before. As a result, some demands to replace
the informal care services that fall behind with formal care
services are getting more and more day by day.
On the other hand, demographic transformations have been
as effective as the changes discussed above in the change of inter-
individual relations. In addition to individuals’ living longer, the
increase in the divorce rate and the number of single parents; the
return from the traditional family structure to nuclear families and
the women starting to be active in working life have weakened the
strong position of older adults inside the family that they used to
have before and this case has threatened the informal support
mechanisms (Akgeyik, 2006, p. 59; Bayoğlu, 2011, p. 125).
Furthermore, children’s immigration from the country to the city,
the increase in cultural conflicts between the old and the young,
and social and economic deprivation have all weakened the strong
positions of older adults (Saka and Varol, 2007, p. 209). Despite
all these things, however, several studies are showing that older
adults still prefer to be looked after in a traditional way inside the
family rather than in institutional care (Karahan and Güven, 2002).
Thus, the rate of the nuclear families in Turkey is extremely
high, 87%, while the large family rate is only 12.3% (AITFS,
2014, p. 29). The functional existence of the large family and
relationships with family members is still kept. That is, even if the
family members live in different houses, the solidarity among
them continues. That is why; it is more common in Turkey to care
older adults both financially and physically by the family when it
is compared to other Western societies (SPO, 2007, p. 103;
Cankurtaran and Eker, 2007, p. 66). Furthermore, older adults,
too, try to have this large family structure.
In fact, even if the majority of older population experience
neglect or abuse, they may prefer to stay quiet because of the
social pressure to be condemned or pointed at. In addition, there is

238
always a risk of being taken out of the house and be sent to the
nursing home. This situation is still considered as a shame in
Turkey for older adults whose children are still alive.

Formal Care for Older Adults

Formal care for older adults in Turkey has always been weak and
insufficient in contrast to the informal ones. As a matter of fact,
the regulation concerning the care for older adults consists of only
a few weak strategy documents and a few articles in law.
Moreover, a strong and developed institutionalization has not been
achieved yet. The insufficiency in these applications can be
explained with traditionally strong and effective informal
applications to a point. More clearly, a lot of social protection
services, which must normally be done by the state as the rights-
based entitlement, have been carried out with informal and
voluntary branches such as the family, relatives, and charities. As
a result, the state has a seconder and complement role. That means
the governments have benefited from the informal and voluntary
sectors as they decrease the expenses of older persons’ care.
As in many other countries, in Turkey, too, the formal
protection system of older adults is a social security system as it
was stated in the 1982 Constitution. Older people need to have
worked and made a payment of premium for a period of time if
they want to be included in the social security scheme. Not only
the social security system provides regular income for older adults
every month both in the active work period and retirement period,
but it also offers a health service for older adults and those under
their responsibility.
When we look at the insufficient regulations for older
persons’ care in a chronological way, the first thing that we see is
the one in 1930, 1580 Article in Municipalities Law. This law says
that the responsibility for the protection of older adults who need
care is given to the municipalities. Apart from this, the General
Directorate of Social Services was founded referring to the
Ministry of Health and Social Aid Organic Law, 3017, in 1963
with the Law Article 17. Therefore, it became possible to give
holistic care services compatible with human dignity rather than
irregular and unplanned in-kind and in-cash services by public and

239
private foundations. The first nursing home was opened in 1966
under the General Directorate of Social Services. It can be noticed
that this is a highly late precaution that was put into effect and
older persons’ care has been left to the family-based informal
networks for long years.
This weak legal frame has emerged even though it is an
issue mentioned in the Constitution, too. The Article 61 of the
Constitution of 1982 has stated that children, older adults, and the
people with disabilities who need to be protected, cared, and
rehabilitated will have the priority and the state is responsible for
funding or building necessary foundations. There is also law
enforcement in the same Article concerning older adults: “the state
protects older adults. Law regulates the aid to older adults by the
state and other rights.” In this context, Law on Social Services and
Child Protection Institution was introduced with law number 2828
(SHÇEK). The 9th Article of this legislation and part b defined
that it is the duty of the General Ministry of Family and Social
Politics to determine, protect, care, and rehabilitate children, older
adults and people with disabilities that need to be protected, cared,
and rehabilitated. In 2011, Directorate General of Services for
Persons with Disabilities and Older Adults was founded under the
General Ministry of Family and Social Politics. Thus, all the
services for older adults are provided by nursing homes, older
adults care houses and rehabilitation centers.

Nursing Homes
Nursing homes can be run by the Ministry of Family and Social
Politics, Directorate General of Services for Persons with
Disabilities and Older Adults, other ministries, municipalities,
foundations, associations, and minorities to meet the physical,
social, and psychological needs of older adults over 60. Besides
these, other nursing homes belong to the private sector.

240
Table 3 The Number of Nursing Homes, Their Capacity,
and Rate of Their Occupancy, 2015
Type of The The The Occupancy
nursing number of capacity population rate (%)
home homes of cared
people
Total 350 28 769 23 132 80,4
Old peoples’
houses under
Directorate
General of
Services for 131 13 391 12 202 91,1
Persons with
Disabilities
and Older
Adults
Old peoples’
houses under
2 570 566 99,3
other
ministries
Old peoples’
houses under 21 2 915 2 041 70,0
municipalities
Old peoples’
houses under
Foundations 28 2 324 1 626 70,0
and
Assemblies
Old peoples’
houses
belonging to 5 508 355 69,9
minority
groups
Private Old
peoples’ 163 9 061 6 342 70,0
houses
Source: TurkStat, Statistically Older Adults, 2015; the Ministry of
Family and Social Politics (from December 2015).

241
 Even though the nursing homes are opened under several
institutions, the municipalities come one step forward on this issue
because the basic service providers are the municipalities. Since
1930, as required by the law, they have been responsible for
opening guests’ houses, almshouses for groups who are in need,
including older adults. Moreover, as it can be seen in Table 3,
several non-governmental organizations and a number of private
care houses run by minorities and natural, legal people provide
older adults with necessary care and social protection (Karagel,
2011, p. 62; TYDYUEP, 2013, p. 12).
There are certain conditions for older adults to be accepted
to these care houses or nursing homes. For instance, they have to
prove with an income test that they are socioeconomically in need
of care. Their health condition comes next. In fact, being healthy
and being able to meet their basic needs is the first condition that
is necessary to be accepted by these places. In other words, older
adults being able to perform their daily activities independently,
not having a disability or a disease and not being addicted to drugs
or alcohol (Saka and Varol, 2007, p. 20).

Care at Home
Many studies in today’s world show that older adults hold a hope
to grow old in an environment where they are used to live with
their beloved ones. It is claimed that this is much more humane
than nursing homes or care houses no matter how comfortable
they are. With this process that is called “ageing in place” older
adults live in the society and lead a normal life, and thus they can
protect their physical and mental health, and they can get much
more pleasure in life. Ageing in place is basically an application
that can be included in the category of social-based care for older
adults. Moreover, the application of ageing in place is a
remarkable step that helps social-based care services to spread.
However, ageing in place does not mean the imprisonment
of older adults in the house. That is different from the traditional
family care because in this application, experts who have medical,
physical, and physiological training are employed, and older
adults are aimed to spend a successful ageing period. While doing
this, they are not taken out of the environment that they are used

242
to. It is aimed that older adults should have a happier ageing
period without being exposed to the exclusion from the society.
So, it is a formal system applied by the state, which is entirely
different from the traditional, informal caring system where wives,
children and even grandchildren look after their own older adults.
The application of care at home that can be considered as an
example for ageing in place has been actualized in recent periods
in Turkey. The application of care at home, as stated in the 10th
Development Plan, has been performed with the aim of
compensating the deficiency in quality and capacity of older
persons’ care. Hence, it was definitely stated that the quality and
capacity of the care at home institutions would be promoted (10th
Development Plan, 2014, p. 44).
In Turkey, care centers for older adults, working under the
Ministry of Family and Social Policies, are charged with providing
care systems at home as much as they can stay “within the bounds
of possibility.” However, naturally, there are some conditions for
those who want to benefit from care at home system. First of all,
they need to be psychologically, physiologically, and physically
healthy and they must not have a condition that requires a
continuous medical care. In addition, there is another must that the
care which is given by family members or other assisting members
such as a neighbor or a relative is not sufficient and older adults
still need care. The income level of older adults who want to
benefit from these places is taken into consideration, too, in the
care services by both private sectors and public institutional care
houses. Today, there are five care centers for older adults in
Turkey founded with this aim and 1076 older adults are provided
with care in these facilities (TYDYUEP, 2013, pp. 15-16).
It is possible to change this situation into an advantage by
integrating the traditional family solidarity with care at home
system. However, it is necessary to approach the situation with a
professional perspective and employ a sufficient number of social
service officers with enough qualifications. This care at home
system, which started legally in 2005, has not been common
enough because these necessities were not fully activated. Care at
home service by the private sector is provided for an insufficient
number of older adults only in big cities (Cankurtaran and Eker,

243
2007, p. 68). For this reason, it can be said that Turkey has a very
long way to increase the number of these private or public care
systems.

Precautions in the Governmental Programs and Development

Plans for Older Adults
The planned development period in Turkey started in 1963, and it
continues. Development plans cover 5-year periods, and the 10th
and the recent development plan covers the years 2014-2018. The
development plans are official documents that reveal the
perspectives on older persons’ care problem in years in the
clearest way in Turkey together with government programs. These
plans and programs coincided with all the stages of the
demographical transition period of the population. That is, not
only the first periods when the population was still young, and
there was not the issue of ageing society, but also the periods
when the rate of older adults in the third age started to increase,
and the issue of older persons’ care started to become a serious
problem. The development plans and government programs
continued to be published along with these periods. Naturally,
these plans and programs also show to what extent Turkey was
aware of this new situation and what kind of precautions it was
planning against the projections pointing at the fourth age matter.
In short, these plans and programs clearly reveal whether there
was a change in politics after the increase in the old age
population in Turkey.
If it is necessary to make a general assignation, the
expressions concerning older persons’ care in the development
plans have not changed in time together with the increase in old
age population. From this result, it is understood that Turkey was
not aware of the fact that there would be different needs for
different age groups and it did not make a separation in the care
and social protection precautions according to ageing categories.
A similar situation is a pic for the question in the government
programs. First of all, old age is holistically evaluated without
being separated into sub-categories in almost all government
programs. An expected result of this is that all the steps were taken
with an assumption that “older adults have monotype needs.”

244
Moreover, ambiguous promises were given about how to meet
these requirements.
At the same time, especially from the beginning of the
twenty-first century, a common expression that was observed in
almost all government programs was the emphasis that older
persons’ care was the family responsibility. Shortly, in every
program, it was promised that care is a priority and that it is
important to meet older adults’ needs, yet it was not discussed
what these requirements were and which policy would be used to
meet them.
Furthermore, older people were not mentioned under a
separate heading in the programs that coincided with the
beginning of the planned development years. Older persons were
mentioned together with the people with disabilities who lost their
capacity to work and children in need. Also, many ambiguous
expressions were used such as taking precautions within the
bounds of financial possibility. This perspective and the attitude
towards older persons’ care was kept unchanged in many
programs until today.
Another common point in the government programs was the
emphasis that older people were not only the government’s
responsibility. Collaborations with voluntary foundations would
be made. The collaboration between the informal voluntary
foundations and the state is necessary only when they act together
in older persons’ care and share the roles. In other words, the state
must always be the leading actor in social assistance and social
service. Other informal and voluntary applications only complete
and help the state. When the government programs and
development plans are examined, it is understood that the leading
role in older persons’ care is dominantly the informal and
voluntary mechanisms, mainly the family. That is, older persons’
care is tried to be solved by traditional solidarity networks among
individuals. This method may not seem to be a problem when the
population was young and dynamic, and the traditional family
structure was not ruined. However, even in the periods when the
rate of older adults in the third and fourth age category started to
increase rapidly, Turkey was observed to be in an attempt to leave
this responsibility to the informal and voluntary mechanisms.

245
Therefore, Turkey does not seem to be aware of the fourth age
problem and the needs of this category; it applies the approaches
for the third age that it used to apply to previous periods.
The need of institutionalization was firstly mentioned at the
beginning of the 1970s, 50 years after the proclamation of the
Republic. As well as being very late, these first discussions were
rather weak. For instance, it was mentioned that care houses for
the poor and weak citizens would be built (31st Government
Program; 3rd Development Plan, 1973), and it did not go further
than being a kindly promise. As it can obviously be seen in Table
3, a desirable institutionalization has not been achieved up to date.
In addition, rights-based and institutional promises were
continuously emphasized to go with collaboration with voluntary
and informal mechanisms.
It is observed that the emphasis on older adults increased
both in the government programs and development plans in later
years. Also, the state started to have a self-criticism about older
persons’ care. According to this, it was obviously stated that the
content of the social services and social assistance programs were
very limited; the number of those who benefit from these services
was very low; the funds that were to be put aside from the public
sources was not enough (4th Development Plan, 1979, p. 143).
These periods were when the immigration from villages to cities
got faster, and the family structure started to change. While the
traditional family structure was replaced by nuclear families, the
period when the female children were in school extended. This led
them to query their roles inside the family. The state tried to fill in
this gap with the emphasis that private entrepreneurship for older
persons’ care would be promoted (4th Development Plan, 1979, p.
285). This situation shows that the state has not changed its
perspective to older persons’ care; instead of developing rights-
based mechanisms, it looks for alternatives to set collaborations.
Apart from the emphasis on the institutionalization, the
promises to “let all older persons in need have a salary”-which can
be called as another rights-based approach, started to go up
together with the law which was put into effect in 1976. This
promise is actually suitable for the state’s general perspective to
older persons’ care issue. Because older persons services have

246
been designed for the indigent old people and the financial
dimension of the problem has been highlighted. Instead of
applying welfare policies for all older adults, the state firstly felt
responsible for providing them with social protection for the
indigent ones. Yet, in time, even if the financial possibilities have
increased, this policy has stayed the same.
The 6th Development Plan covering the years between 1990
and 1994 is certainly separated from the other plans. Because of
the idea that older persons’ care is a problem that must be solved
inside the family was clearly and definitely expressed for the first
time in these years, and it was repeated in the same way in other
plans, too. That is, older persons’ care by the family members was
mentioned as the certain target instead of institutional care. It was
stated that the limited care and protection service the state would
offer to old people would be designed mainly for the family, not
directly for older adults themselves. By doing so, the state wants
to institutionalize the function of the family (6th Development
Plan, 1990, p. 305).
While the state is promoting the emphasis on the family, it
seems aware of the insufficiency of the informal mechanisms. As
a matter of fact, together with the beginning of the 2000s, it was
observed that the state started to be aware of the rapid increase in
old age population. After it was determined that this increase in
old age population would raise the need for the Old Peoples’
House and Older Adults’ Counselling Centre (8th Development
Plan, 2001, p. 111), it was stated that a new institutional structure
responsible for the management and the coordination of designing
every kind of social service and social assistance program would
be formed with the aim of improving these social services.
As we come to our time, the emphasis on the rise of old age
population has been mentioned together with the determinations
concerning the changes in the family structures. In the 9th
Development Plan, which covers the years 2007 and 2013, after
stating that the family may not do its traditional responsibilities,
promises were given such as the importance of older persons’
services would rise, and there would be more various services. As
a result of this context, the support of older persons’ care services
was promised for the first time; it was also promised that the

247
quantity and quality of the old peoples’ houses would be
increased. In other words, while the state was talking about the
number of the institutional and rights-based investments would be
made and, it was trying to revive the traditional role and
responsibility of the family and looking for new ways and
methods for older persons’ care at home.
The most detailed determination of older persons’ care and
a plan of promises is the 10th Development Plan. In this plan, it
was stated that social assistance and standards need to be created,
qualified staff needs to be employed, controls must be increased,
and the services for older adults must be diversified and made
common. In addition, it was expressed that the quality and
quantity of the institutional care would be increased without taking
older adults out of their environment (10th Development Plan,
2014, pp. 43-44).
Another focus was made on the solidarity between
generations. It was also stated that the capacity of the local public
services would be increased with the aim of easing the access to
these services because of the decrease in the population density in
villages and innovative models would be developed. It was also
focused that it was necessary to increase older persons’ care
services in order to encourage more women to join the labor force.
It was underlined that social assistance and services need to be
offered as family-based in the framework of the Program of
Protection of the Family Dynamics Population Structure (10th
Development Plan, 2014).
As it can be understood from this last plan, the state has just
started to understand the seriousness of older persons’ care issue
in Turkey. Even though very clear rights-based and institutional
promises were given, it is still at the stage of intention and
planning. Moreover, there are many insufficiencies in the
application.
Turkey is a country, which is ageing extremely fast on the
one hand and which is going through a family-based
transformation process on the other; so, it will be right to apply
much more systematic and rights-based strategies in such a
country. However, care services in Turkey are problematic. The
staffs are sufficient neither in numeric nor the level of

248
specialization. The social service staff, such as professional
therapists, physiotherapists, geriatric psychiatrists, and geriatric
nurses can only be found commonly in big cities (Cankurtaran and
Eker, 2007, p. 68).
Because of this institutional insufficiency for infrastructure,
the governments in Turkey prefer leaving the issue of older
persons’ care to informal and voluntary mechanisms, mainly the
family. These informal and voluntary mechanisms can only be
used to complete the gaps of the state; they cannot fully replace
the state’s institutional and rights-based responsibilities and they
should not. Despite this universal fact, it is understood that the
issue of older persons’ care is recently included in the government
programs and development plans. As a matter of fact, the state
emphasizes to empower the informal mechanisms instead of
rights-based and systematic applications. Turkey urgently needs
specific policies and programs for the fourth group where old age
population is rapidly increasing, because it is not possible to meet
the needs of the fourth age group with steps and promises
concerning the third age group.

Conclusion
It is certain that Turkey is going through a demographically new
period. The average lifespan is increasing day by day due to some
progress such as improvements in the nutrition and healthcare,
developments in general welfare, and slowdowns in birth-rate.
That is why; the rate of older adults in the total population is
growing a lot faster compared to those in other age groups. This
increase in old age population will lead to serious problems for the
living standards of older adults, and their needs, especially for
social and special care services. There is an incompatibility
between formal and informal mechanisms when meeting the
caring requirements of older persons and providing them with
social security services. The traditional solidarity of families has
become the principal mechanism responsible for older persons’
care for long years, so the formal structure has become extremely
insufficient. This family-based caring system has lost its
importance in today’s world because of a series of socio-economic
and cultural reasons. Despite this, the state is understood to have a

249
tendency to reactivate these informal mechanisms, and it tends to
solve the problem by having a collaboration with them instead of
accepting itself as the fundamental responsibility for older
persons’ care.
There is a lot larger old age population in today’s world,
and they do not belong to one population group. The distinction
between the third and the fourth age among old people has been
clearer for a long time, and this distinction will be much sharper in
the very near future. It is also predicted that especially the fourth
age group will increase rapidly. Therefore, it has become difficult
to solve this population ageing problem and the care needs of
older persons via informal networks. The state certainly needs to
develop formal and rights-based methods. However, when the
development plans and government programs covering the last 50
years are examined, it is understood that Turkey is not aware of
the urgency of the problem. It still approaches this serious issue
with the wording and precautions used when the old age
population was less dense. It is not possible yet to claim that
precautions and declarations related to the fourth age group have
been made. The state is in an effort to solve this fourth age
problem which is approaching rapidly with old methods and is
focusing the importance of the family, and it goes on making
collaboration plans with informal, voluntary, and private sectors.
These informal mechanisms which are directly effective on
the older persons caring system and having a united society and
interpersonal solidarity should, of course, be included in the care
system as long as they do not take over the rights-based roles that
normally belong to the state. Otherwise, a very critically sensitive
issue such as the social security of older adults will have to be left
to the philanthropist applications and benevolent feelings.
In older persons’ care, it is of course, very important not to
take older adults out of their natural environment. This can be
summarized as ageing in place, and in this concept, older adults
get older peacefully, happily and by joining the society. In Turkey,
in fact, the governments are trying to encourage those people to
live with their families instead of putting them into public
buildings. The family and the fact that old person is not taken out
of his natural environment has a great importance in older

250
persons’ care. This can be summarized as “ageing in place”
because they get older in their natural environments, happily,
peacefully and taking active roles in the society. In Turkey, the
government is trying to encourage older adults to grow older
inside their homes near their relatives instead of living in nursing
homes. This attempt is highlighted in almost all development
plans and governmental projects. However, the policy for ageing
in place requires more than that. First of all, ageing in place should
be done via the social experts employed by the state rather than
informal family solidarity. Especially, the project of older persons’
care at home is an important step as promised in recent
development plans and governmental programs. However, it has a
limited area for the application. The rights-based older persons
caring system will be set by employing efficient expert staff, by
holding training programs and seminars about the issue and by
giving technical support.
For the final word, even though it has a very rapidly ageing
population structure, Turkey is understood to be slow at taking
necessary precautions in a formal context. Traditional family-
based informal mechanisms are successful at older persons’ care
to a point, and after that point, formal, systematic, foundational,
and rights-based applications are definitely necessary. However,
before that, Turkey needs to realize that there is a difference
between “the third age” and “the fourth age,” and that older adults
have different requirements at various stages of the life course.
Only after this, it will be able to produce different policies for
diverse needs and demands of old age groups.

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